Advocates fight to get birth certificates for stillborn babies in Pennsylvania

When Mandy Mancini went into labor three years ago she expected to come home from the hospital with a healthy baby girl. She left with a heavy heart and empty arms.

Her daughter Seneca was stillborn, leaving Mancini with only a scrapbook of memories, a plaster mold of her tiny feet, a commissioned portrait and pictures of a baby frozen in time.

''She had two little feet, 10 toes and fingers and she looked just perfect,'' said Mancini, of Breinigsville. ''Except she never opened her eyes or cried or took a breath.''

That fact, Mancini learned later, would make it impossible for her to obtain what she considers the most precious memento  a birth certificate and recognition that she birthed a full-term baby.

About one in 160 pregnancies results in stillbirth, generally defined as naturally occurring fetal death after 20 weeks of gestation. In up to half of all stillbirths, the cause of death can't be determined.

For many parents of stillborns, a birth certificate is a purely symbolic but nonetheless precious document.

Almost 30 states, including neighboring New Jersey, have laws that direct health departments to issue birth certificates for births resulting in stillbirth if a parent requests one.

Pennsylvania law doesn't provide for stillborn birth certificates. But Mancini's grandmother, Dorothy Knappenberger of South Whitehall Township, is leading a grass-roots movement to change the law.

For Knappenberger, 73, the drive to push the legislation forward is about a silent promise she made to her stillborn great-granddaughter: ''I said 'Seneca, God willing I'm here long enough, you're going to get a birth certificate,''' Knappenberger said.

Knappenberger started a Facebook page, now with 400 friends, and a network of dozens of mothers across Pennsylvania. She's met with lawmakers, lobbyists and officials with the state Department of Health.

Legislation has been in the works for more than 10 years. It has been held up by what proponents say is a silent but powerful undercurrent of opposition to a bill that skirts the abortion debate. Abortion-rights advocates are wary of the legislation because, they fear, it could imply a fetus is a person and fuel anti-abortion arguments.

But as long as the legislation is carefully worded and birth certificates for stillborns are optional for parents, Planned Parenthood does not oppose them, said Kay Haring, spokeswoman for Planned Parenthood in Pennsylvania.

Haring said Planned Parenthood just wants to maintain the distinction between live births and fetal deaths.

The state Health Department has historically opposed the bill for reasons officials have declined to discuss, citing a policy against commenting on pending legislation.

Gary Tuma, Gov. Ed Rendell's spokesman, said new leaders in the department have recently decided to review the opposition to the legislation. He cited legal issues, opportunity for fraud, identity theft and the creation of new Social Security numbers as reasons the department has historically opposed it.

In addition, Tuma said, the department already offers certificates of stillbirth to parents who request them. The certificates have been available since 2005.

But unlike the birth certificates that would be issued under proposed legislation, the certificates the department provides are not legal documents, Knappenberger said. They would not be registered in vital statistics. According to state law, parents receive death certificates for stillborns.

Tuma said the Health Department would also have to review the cost of implementing the new law.

The $9 cost of the certificate, under the proposed legislation, would cover administrative costs, said state Sen. Pat Browne, R-Lehigh, who is co-sponsoring the legislation.

In New Jersey  which has issued just over 200 certificates of birth for stillborns since November 2008, when legislation passed  the certificates cost $25, the same as other vital records, and have not resulted in any additional costs for the department, said Marilyn Riley, a spokeswoman for the state Department of Health and Senior Services.

For Joanne Cacciatore  a grief counselor in Arizona who is spearheading the national push to get states to adopt stillborn birth certificate legislation  arguments about cost and identity theft are really a smokescreen.

In her experience, Cacciatore said, the opposition really centers on abortion, to the detriment of what she and other mothers of stillborns are trying to accomplish.

''This is the ultimate women's issue,'' she said. ''Giving birth is a uniquely feminine experience.''

Whether individual legislators see it that way is sometimes difficult to discern, Cacciatore said.

''The problem is that what people say publicly is different than what is going on behind the scenes,'' she said.